Bible Studies


The Ministry of Mercy

Reflections on the Roles of Church and State in Modern Health Care

It is a grand thing to think about the Church’s role in the ministry of mercy over the centuries, but we need to flesh out practical aspects of what this means realistically in the twenty-first century. Take the issue of health care. This historically has been a major way that the Church has ministered to people down through the centuries. As Scripture teaches, we have an obligation to help our own as well as society as a whole: “Therefore, as we have opportunity, let us do good to all people, especially to those who belong to the family of believers.” (Galatians 6:10.)

Until the latter third of the twentieth century, the Church effectively ministered to society in a variety of ways, including not only schools, but homes for the poor, orphanages and institutions that care for the sick. One has but to witness the significant number of hospitals that have “Presbyterian,” “Baptist,” “Methodist,” “Saint Luke’s” and “Sisters of Charity” as part of their name to confirm this. However, I submit that things have become increasingly difficult for the Church to carry out her historic role, particularly in the area of medicine. Let’s consider several things because the cost of modern health care is driven up by many factors, including scientific advances, federal funding and private insurance.

The most significant of these is the cost of modern, scientific medical care. We have a lot of physicians in our congregation, two of whom are radiologists, a branch of medicine that didn’t even exist until well into the twentieth century, long after the research of Manja Sklodowska Curie and her husband Pierre began to work itself out practically. The cost of a modern radiology center is enormous, but it is hard to calculate the blessings that such a center provides. I’ve sat in the cold, dark room where radiologists study the magnetic resonance images and cross-sectional views of internal body structures that their computers produce with axial tomography. It is simply amazing what we can see, and we are probably not far from being able to avoid exploratory surgery completely, given these advances. But these devices cost enormously, and the only way that we can afford them is for the costs to be spread out over a large economic base.

A second factor, one that has helped to make these scientific advances possible in a practical way, is our changing economic system and the role of government. The role of government, particularly that of the federal government in the United States, has changed enormously over my brief lifetime. I remember the late Strom Thurmond addressing our high school, warning us about the dangers of the encroaching power of the federal government. At that time, he told us, South Carolina did not receive any federal money for education, and he didn’t want to see that changed because he knew that with that money would come increasing government control over education. He was right, of course: with increasing federal funding has come increasing nationalization, not only of education, but of so much else in our lives.

In the first half of the twentieth century, the federal government set about to improve people’s lives in a way unprecedented in history, and as it has done so. Not only has our standard of living risen enormously, so has the size and cost of goverment, along with its control. Almost all of us have become so dependent on the federal government that it is hard to imagine what life would be like without it.

We need to be realistic about this: if we believe that we need to change this system, we need to adopt a gradual rather than a radical approach. Suddenly to dismantle what has slowly been erected over the past century, especially since August 14, 1935, would absolutely destroy our economic and social infrastructure as a nation. Furthermore, getting down to brass-tacks, the political reality of the situation is that consistent, true economic conservatives are probably less than one-percent of the American electorate. What do I mean?

Almost all fiscal conservatives want to “cut the budget,” but almost without exception, they raise Cain when it comes to any significant cut in what they believe they are personally entitled to, whether it’s Social Security, federal highways or Veterans’ benefits. The fact of the matter is that virtually all Americans believe in “entitlements.” They may get their dander up over those “entitlements” for others, but their own are sacrosanct, and pity the political leader who raises a hand against them.

Economically, the United States has a blended economic system, and we neither embrace laissez-faire capitalism nor socialism. Instead we blend the two in a somewhat fascist (I’m not using the word pejoratively but realistically.) economic system, where the federal government is intricately intertwined with private business. Outside of the “military industrial complex,” nowhere is this truer than with regard to health care. Where would Senate Majority Leader, Bill Frist, M.D., be without the federal government’s economically undergirding his family’s business, the Hospital Corporation of America?

Lastly, alongside the economic growth of the health care industry and the steady encroachment of the federal government is the relative dwindling of the economic base of the Church. Notice that I said “relative,” because Church budgets are much, much larger, as well as pastors’ salaries, than in the past. But consider only one aspect of the cost of doing the business of the Church, pastors’ insurance packages. It costs our congregation over twelve thousand dollars a year to purchase insurance for a single employee. But what are our alternatives? One case of open-heart surgery, and our congregation would be financially destroyed without health insurance for our employees.

Factor in along with this the declining role of most denominations, and the expansion of the role of the Church becomes even more unlikely. People simply are not loyal to denominations the way that they were a generation or two back—certainly that’s true with respect to the mainline Protestant groups. Then think about the realities facing the newer, more conservative denominations. The older denominations have usually had lots of resources, some stretching back over a century or more, but the newer ones have had to scramble and do a lot of stuff on a shoe-string just to erect some kind of denominational structure simply for such things as insurance and annuities for pastors, let alone caring for their memberships at large. I’m not saying that it’s impossible, just that it is far more difficult for the denominations to which many people belong to undertake the kinds of things our spiritual ancestors did generations ago.

Let’s be realistic here and come down out of our ivory towers: most of our churches can do a lot more things than we do now. We can set up schools and centers to minister to the poor, but we simply cannot take over health care the way we did in past generations, given the world in which we find ourselves. Health care is a burden to be borne Christianly; however, and all our people should have access to it regardless of their ability to pay.

And so, my fellow Americans, ask not that your federal government cut back on its role in modern life as a whole in glittering generalities; ask what “entitlement” you would have government cut from your life. (With apologies to John F. Kennedy.)

Bob Vincent